Cystic neoplasms of the pancreas represent about 10% of all cysts of the pancreas and ~1% of all pancreatic neoplasms. Much has been learned about the natural history and management of these tumors in the past decade. We are finding more of these lesions than in years past since so many patients receive ultrasounds or CT scans for other reasons and these tumors are found incidentally. Cystic neoplasms are subdivided into serous, mucinous and intraductal papillary mucinous neoplasms. These lesions are described separately on this website but a few generalities pertain to all. The most important aspect of these lesions is to recognize them. They must be differentiated from benign pancreatic cysts as the treatment is distinctly different. Differentiation of benign cysts from cystic neoplasms of the pancreas can usually be made by a good history and physical exam by a physician familiar with these disorders. If a cystic neoplasm is suspected and the patient is symptomatic (abdominal pain), surgical removal is recommended. Most authorities feel that small lesions (<3cm) that do not cause abdominal pain or obstruction of the main pancreatic duct may be safely observed with close surveillance. In contradistinction, lesions larger than 3cm, those that cause symptoms or those that obstruct the main pancreatic duct should be removed not only to relieve symptoms but also because the incidence of cancer is higher. Our knowledge and treatment of these disorders is rapidly changing and recommendations for treatment may change in the future. Overall, the prognosis for these lesions, even if cancer is present, is markedly better than that for routine pancreatic adenocarcinoma if the these tumors can be surgically removed.